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The Effect of Early Parent‐Infant Contact on Newborn Body Temperature
research and st The Effect of Early ParentInfant Contact on Newborn Body Temperature SUSAN T. HILL, RN, a n d LUCILLE K. SHRONK, RN, BSN T o determine whether infants who are properly dried and wrapped can be held and warned by parents in the delivery room without suyering a signiJicant heat loss, temperatures of 100 infants were monitored with electronic thermometers aJer deliuery; 50 were held by one or both parents and 50 were not held but immediately placed in a heated transporter. A two-tailed t test showed no signijicant difference between temperatures of the two groups.
T h e r e is some concern a m o n g grade. The fall is most rapid in the perinatologists, neonatologists, and initial minutes after birth, at which time others that when parents are allowed rate of fall in deep body and skin temto hold, fondle, and examine their perature is about 0.1OC (0.18’F) per newborns immediately after deliv- minute and 0.3”C (0.54’F), respectively, corresponding to a heat loss of approxiery, the newborns experience exces- mately 200 calories per kilogram per sive heat loss. Emphasis is placed on minute. quickly ushering newborns to mechanically heated devices. This alHeat loss in the newborn occurs lows l i t t l e o p p o r t u n i t y for t h e from the skin surface by 1) evaporamother and/or father to experience tion, 2) convection, 3) conduction, contact with their newborn until and 4) radiation. In contrast to the some hours later when the baby’s adult, who compensates for heat loss temperature is considered stable. by shivering and muscle contraction, For the comfort of the mother, the response of the newborn maniand medical and nursing personnel, fests itself in physical movement to the majority of delivery rooms are lessen exposure and in metabolic acair-conditioned. For this reason and tivities, one of which is non-shiverothers, immediately after birth, the ing thermogenesis (NST) I; however, newborn begins to lose a significant there may be some delay in the newquantity of heat. An initial cold born’s ability to activate NST’, and stress may serve as a stimulus for even then, the newborn’s energy rebreathing.’ There is also evidence sources for NST may be quickly desupporting the fact that there is a pleted. decrease in homeothermic responGestational age, maternal sedasiveness in newborns who do not extion, and central nervous system perience initial cold stress.’ However, excessive heat loss should be disorders in t h e i n f a n t , such as meningomyelocele, also affect temavoided. T h e following h a s also b e e n perature regulation in the newborn. noted2: While cold stress can cause acidUnder normal delivery room condi- osis and hypoglycemia in the newtions, deep body temperatures of the hu- born, an environment which is too m a n newborn fall ‘2 to 3 degrees centi- warm can also stimulate excessive Septernber/October 1979JOCN Nursinp
O09O-O311/7~/O9I3-0287$01OO
metabolic work.’ When prolonged, the newborn’s methods of heat dissipation can lead to complications of hypothermia, i.e., acidosis, hypoglycemia, as the infant fights to keep cool. Do all of these newborn physiologic reactions to changes in tempera t u r e s u p p o r t t h e p r a c t i c e of denying parents anything more than a cursory glance at their newborn after birth? Can slight adaptations in delivery room routines maintain the temperature of the newborn sufficiently to allow parents more time to become acquainted with their newborn? T h e authors could find only two studies which directly relate to these q u e s t i o n s . I n 1970, D a h m a n d James4 compared five groups of infants, each group consisting of 10 infants who were assigned before delivery to one of five environmental conditions in the delivery room. T h e conclusion: “In vigorous infants, the simple m a n e u v e r of d r y i n g a n d wrapping in a warm blanket is almost as effective in diminishing heat loss, as placing them under a radiant heater.” In 1974, Phillips’ studied 115 infants delivered at Watsonville Community Hospital and Santa Cruz Community Hospital between July of 1973 and January of 1974. T w o delivery rooms were used and t h e environmental temperatures of each room were recorded at the same time as the rectal temperatures of the infants. Ambient temperature was stable at 72°F in one delivery room and at 75°F in the second delivery room. Two groups of infants were used. In one group, 65 infants were held by the mothers on the delivery table; in the other group, 50 infants were placed in heated beds. All infants were dried and wrapped, and rectal temperatures were taken at 5 and 15 minutes after birth. T h e temperatures of the two groups were compared. T h e conclusion: “ T h e procedure of removing a normal newborn from his mother and placing him in a heated bed to keep him warm may be unnecessary.” T h e authors could find no study which focused o n the probability that the parents’ body heat might
28 7
Table 1. Mean Rectal Temperatures Among 100 Newborns with Two Sources’ of External Heat
Pooled T Value
Variance Degrees of Freedom
Estimate 2-Tail Probability
0.604
-0.46
98
0.650
1.16
0.609
- 1.40
98
0.165
1.09
0.769
-0.85
98
0.396
0.’12 0.1 32
1.39
0.254
0.79
98
0.429
0.099 0.107
1.17
0.593
0.51
98
0.612
Newborns Number
Temperatures
SDt
TEMP 1- After routine care not held 50 98.6416 0.993 held 50 98.7357 1.070 TEMP 2-After five minutes (held or in transporter) not held 50 97.7477 0.993 held 50 98.01 56 0.923 TEMP 3--On admission to nursery not held 50 97.1 357 0.942 held 50 97.2998 0.983 TEMP 4--First follow-up temperature in nursery not held 50 98.3756 0.794 held 50 98.2377 0.936 TEMP 5--Second follow-up temperature in nursery not held 50 98.5576 0.698 held 50 98.4836 0.754
F Value
2-Tail Probability
0‘140 0.151
1.16
0’140 0.1 31
SES
0.139
Held by parent in room with mean temperature 70.9600 or placed in transporter with mean temperature 83.6200
t Standard Deviation $ Standard Error
Data were collected when staff was adequate and sufficient time was available, from August 1977 through October 1977 at Pennsylvania Hospital. During this period there were approximately 750 deliveries. Because the majority of deliveries occurred in delivery rooms 1 and 4, only these rooms were used for the study. A room temperature ranging from 68’ to 72°F was maintained. The formal criteria for sample selection were as follows: 1) newborn weighed over 5+ pounds, 2) normal labor and vaginal delivery, 3) Apgar score of 7-10 at five minutes, and 4) no newborn complications. A checklist was posted in each delivery room for the purpose of recording the following: whether the infant was held or placed in the transporter; the newborn’s name; Methods and Material rectal temperature after routine T h e study was experimental, with care; rectal temperature five minutes a sample of 100 infants. A control later; room or transporter tempergroup of 50 infants not held but ature at same time as rectal temperplaced in the transporter and an ex- atures; and whether or not sedation perimental group of 50 infants held h a d been administered t o t h e by the mother and/or father were mother immediately before delivery. used. The staff was instructed in the Rectal temperatures were monitored methods for gathering data, proce- with electronic thermometers. With both groups, after the baby dures, and selection criteria. (To ensure uniform procedure, a pilot pack had been opened, two baby study had been conducted for a pe- blankets had been placed in the riod of one week.) transporter to be warmed by its
serve as a source of warmth for their newborn and thus prevent excessive heat loss. [Editor’s note: However, one such study has since appeared in JOGN. See Gardner S: The mother as incubator-after delivery, JOGN 8:174- 176, May/June 1979. Please also refer to this article for a fuller review of newborn heat loss, heat loss compensation, and heat dissipation.] T h e purpose of this research was to test the hypothesis that if the newborn is dried, given initial care, properly wrapped, and then placed in the mother’s and/or father’s arms for a period of five minutes, there will not be a significant decrease in the newborn’s temperature as compared to newborns who are not held but placed in a heated transporter.
288
heating element. One of these blankets was then used to wrap the baby during the weighing. In conjunction with this, to minimize convective heat loss, the scale was moved in close proximity to the IMI (radiant heat bed). The staff had been reminded of the method of properly drying and wrapping the baby with special emphasis placed on covering the head. Both groups of infants were wrapped in the second warmed blanket. Both groups arrived in the nursery via warmed transporter within 40 minutes following delivery. Admission temperatures were recorded and follow-up temperatures were obtained according to nursery routine, i.e., 8:OO AM and 4:OO PM. This information was gathered by the authors.
Analysis of Data Means and standard deviations of both groups’ temperatures were calculated for all five temperature recordings (see Table 1). The t test for significant difference between temperature readings of the control and experimental groups was used. In addition to these, cross-tabulations were employed for all five temperature recordings of each group to determine incidence of temperatures falling within the normal range (97-
99'F)' or otherwise. T h e decision to use these values as the normal range was based on the fact that most authorities refer to a normal range of temperature rather than a specific average temperature, although average temperature ranges do differ from study to study." According to one author, the rectal temperatures of infants varies between 97.6' and 99.8"F, with an occasional range of 97.0' to 100.6"F.' Another author found that temperatures as low as 97.O"F and as high as lOO'F occurred in normal newborns.8 A range as wide as 96" to 99.5'F was cited by another pair of authors;" however, most sources agree that rectal temperatures should not fall below 97°F." A range of 97' to 99OF falls within the normal ranges observed by the above authors and was thus designated as the normal range for this study.
Results Figure 1 shows the mean of each of the five rectal temperature recordings of all 100 newborns. Temperatures taken five minutes after newborns were either held or placed in the heated transporters decreased nearly l'F, falling from 98.6O to 97.8'F. Temperature 3, the temperature obtained on admission to the nursery, proved to be the lowest mean temperature of the five obtained; however, it was still within a normal range (97'-99'F) at 97.2'F. Means of two follow-up temperatures show an inclination to return to a range closer to Temperature 1, the first taken after delivery, with a difference of 0.168"F between Temperatures 1 and 4, the first temperature taken in the nursery. Table 1 compares the mean rectal temperatures of the control and experimental groups for each of the five successive recordings. Standard deviations and standard errors of the means are also given in the table. Differences between temperatures of control a n d experimental groups through the five recordings range from 0.0740' to 0.2679'F. The hypothesis, that there is no significant difference in rectal temperatures of newborns held by parents following proper drying and
98.9 98.8 98.7 98.6 98.5 98.4
k Y
98.3
a I
98.1
I
d
Ba
\
98.2
\
i
98.0 97.9 97.8
0
97.7 1
97.6 97.5 I
97.4 97.3
97.1 97.2 97.0
I
: TEMP 1 TEMP 2 TEMP3 TEMP4 TEMPS ~~
Figure 1. Means of successive rectal temperatures of 100 newborns (i.e. both experimental and control groups)
wrapping and newborns not held after the same conditions but placed in a warmed transporter, was confirmed at both the .05 and .01 levels using a two-tailed t test. Table 2 shows comparisons of temperatures 1-5 with a normal temperature range of 97'-99"F. Table 2 shows a close balance between the control and experimental groups and the incidence of normal and abnormal temperature ranges
occurring between them. Temperature 2 shows a slightly higher incidence of below normal range temp e r a t u r e s o c c u r r i n g within t h e control group.
Conclusions According to results plotted in Figure 1, it appears that although newborn body temperatures do show a slight decrease from the initial recording, the decreased temperature
Table 2. Comparison of Mean Rectal Temperatures Among 100 Newborns Below Normal
Normal *
Above Normal
30 28
19 20
35 38
4 6
31 32
2 1
43 41
5
36 39
13
____TEMP 1-After routine care 1 not held 2 held TEMP 2-After five minutes (held or in transporter) 11 not held 6 held TEMP 3---0n admission to nursery 17 not held 17 held TEMP 4-First follow-up temperature in nursery 2 not held 2 held TEMP 5-Second follow-up temperature in nursery 1 not held 1 held
7
10
Normal range = 9 7 " - 9 9 " F
289
reading still remains within the nor- m o n i t o r e d w i t h e l e c t r o n i c thermal range. Also noteworthy is the mometers; there are sources to valifact that temperatures did return to date both pro a n d con opinions. Anwithin 0.2’F of the initial temper- other point which perhaps can be ature recording in a matter of hours. considered a limitation is that the These results indicate that whether time element between the admission h e l d b y p a r e n t s o r not h e l d b u t temperature a n d the first follow-up placed in a heated transporter, new- temperature was not consistent beborns recover the minimal amount cause temperatures after admission to the nursery were taken either at of heat loss suffered. T test results as shown in Table 1 8:OO A M or at 4:OO P M regardless of imply that allowing parents to expe- t i m e of delivery. T h e n of course rience a period of contact with their there is the possibility that d u e to newborns, i.e., allowing t h e m t o human error in d a t a collection all of hold a n d fondle the infant, does not the participants did not conform to affect the newborn body temper- the designated criteria. a t u r e as monitored with a rectal thermometer relative to those new- Implications for Further Research borns who are warmed by mechaniInasmuch as a fair portion of temcal devices. peratures monitored for each of the Cross-tabulations indicate that al- control a n d the experimental groups though t h e numbers of newborns fell below the normal range, a n d falling within the ranges of below more specifically those temperatures normal, normal, a n d above normal taken prior to a n d on admission to for both experimental a n d control the nursery, further research may be groups remain fairly even, a sizeable indicated to determine the optimal number of newborns register tem- ambient temperature in the delivery peratures below normal for Temper- room. atures 2 a n d 3. Also, i n view of t h e l i m i t e d Questions posed by the authors amount of research available cona r e answered as follows: 1) There is cerning the accuracy a n d efficiency n o significant difference in temper- of electronic thermometers, further atures of newborns who are held by research in this area may prove bentheir parents prior to being placed in eficial. a warmer a n d infants who a r e placed directly in a mechanically Acknowledgments heated device. 2) Newborn physioT h e authors wish to express their logic reactions to changes in temper- appreciation to R i t a Morris, R N ; ature do not support the practice of Merle Sutton, RN; the entire labor denying parents anything more than a n d delivery staff a t Pennsylvania a cursory glance at their newborn af- Hospital; Ronald Bolognese, M D ; ter birth. 3) Slight adaptations in de- T h o m a s R. Boggs, M D ; Dorothy livery room routines maintain the Brooten, RN, MSN; a n d Barbara temperature of the newborn suffi- Jacobsen, MS, for their assistance ciently to allow parents more time to a n d support. become acquainted with their newReferences born. 1. Blackburn G, Motil KJ: TemperLimitations ature regulation in the neonate. Clin T h e r e are some who may question Pediatr 12:634-638, 1973 the accuracy of rectal temperatures 2. Phillips CRN: Neonatal heat loss in
290
3.
4.
5.
6. 7. 8.
9. 10.
heated cribs vs. mothers’ arms. JOGN Nurs 3:11-15, 1974 Hull D: Temperature regulation disturbance in the newborn infant. J Clin Endocr Metab 5:39-53, 1976 Dahm LS, James LS: Newborn temperature and calculated heat loss in t h e delivery room. Pediatrics 49:504-512, 1972 Brooten D, Miller MA: The Childbearing Family: A Nursing Perspective. First Edition. Boston, Little Brown, 1977 Eoff MJ, Meier RS, Miller C: Temperature measurement in infants. Nurs Res 23:457-460, 1974 Barnett HL: Pediatrics. Fifteenth Edition. New York, Appleton-Century-Crofts, 1968 Marlow DR: Textbook of Pediatric Nursing. Fourth Edition. Philadelphia, WB Saunders, 1973 Lutz L, Perlstein PH: Temperature control in newborn babies. Nurs Clin N Am 6:15-23, 1971 Vulliamy DG: T h e Newborn Child. Third Edition. Boston, Little, Brown, 1972
Address for correspondence: Susan Hill, RN, Perinatal Testing Nurse, Pennsylvania Hospital, Eighth and Spruce Street, Philadelphia, PA 19107.
Susan Hill is a perinatal testing nurse and coordinator ofthe Program for Childbirth Education at the Pennsylvania Hospital in Philadelphia. She has worked as a staff nurse in labor and delivery and in the intensive care nursery. Ms. Hill received her diploma from the University of Pennsyluania School of Nursing, Philadelphia, and is working toward her BSN from Gwynedd-Mercy College, Gwynedd V a l l v , Pennsylvania. She is a member of NAACOG, ICEA, and CCES. Lucille Shronk recieued her BSNfrom Thomas J elferson University College of Allied Health Sciences, Philadelphia, Pennsylvania. She is a stalfnurse in labor and delivery at I’ennsylvania Hospital, Philadelphia, and is a member of NAACOG.
Septernber/October 1979JOCN Nurung
T h e r e is some concern a m o n g grade. The fall is most rapid in the perinatologists, neonatologists, and initial minutes after birth, at which time others that when parents are allowed rate of fall in deep body and skin temto hold, fondle, and examine their perature is about 0.1OC (0.18’F) per newborns immediately after deliv- minute and 0.3”C (0.54’F), respectively, corresponding to a heat loss of approxiery, the newborns experience exces- mately 200 calories per kilogram per sive heat loss. Emphasis is placed on minute. quickly ushering newborns to mechanically heated devices. This alHeat loss in the newborn occurs lows l i t t l e o p p o r t u n i t y for t h e from the skin surface by 1) evaporamother and/or father to experience tion, 2) convection, 3) conduction, contact with their newborn until and 4) radiation. In contrast to the some hours later when the baby’s adult, who compensates for heat loss temperature is considered stable. by shivering and muscle contraction, For the comfort of the mother, the response of the newborn maniand medical and nursing personnel, fests itself in physical movement to the majority of delivery rooms are lessen exposure and in metabolic acair-conditioned. For this reason and tivities, one of which is non-shiverothers, immediately after birth, the ing thermogenesis (NST) I; however, newborn begins to lose a significant there may be some delay in the newquantity of heat. An initial cold born’s ability to activate NST’, and stress may serve as a stimulus for even then, the newborn’s energy rebreathing.’ There is also evidence sources for NST may be quickly desupporting the fact that there is a pleted. decrease in homeothermic responGestational age, maternal sedasiveness in newborns who do not extion, and central nervous system perience initial cold stress.’ However, excessive heat loss should be disorders in t h e i n f a n t , such as meningomyelocele, also affect temavoided. T h e following h a s also b e e n perature regulation in the newborn. noted2: While cold stress can cause acidUnder normal delivery room condi- osis and hypoglycemia in the newtions, deep body temperatures of the hu- born, an environment which is too m a n newborn fall ‘2 to 3 degrees centi- warm can also stimulate excessive Septernber/October 1979JOCN Nursinp
O09O-O311/7~/O9I3-0287$01OO
metabolic work.’ When prolonged, the newborn’s methods of heat dissipation can lead to complications of hypothermia, i.e., acidosis, hypoglycemia, as the infant fights to keep cool. Do all of these newborn physiologic reactions to changes in tempera t u r e s u p p o r t t h e p r a c t i c e of denying parents anything more than a cursory glance at their newborn after birth? Can slight adaptations in delivery room routines maintain the temperature of the newborn sufficiently to allow parents more time to become acquainted with their newborn? T h e authors could find only two studies which directly relate to these q u e s t i o n s . I n 1970, D a h m a n d James4 compared five groups of infants, each group consisting of 10 infants who were assigned before delivery to one of five environmental conditions in the delivery room. T h e conclusion: “In vigorous infants, the simple m a n e u v e r of d r y i n g a n d wrapping in a warm blanket is almost as effective in diminishing heat loss, as placing them under a radiant heater.” In 1974, Phillips’ studied 115 infants delivered at Watsonville Community Hospital and Santa Cruz Community Hospital between July of 1973 and January of 1974. T w o delivery rooms were used and t h e environmental temperatures of each room were recorded at the same time as the rectal temperatures of the infants. Ambient temperature was stable at 72°F in one delivery room and at 75°F in the second delivery room. Two groups of infants were used. In one group, 65 infants were held by the mothers on the delivery table; in the other group, 50 infants were placed in heated beds. All infants were dried and wrapped, and rectal temperatures were taken at 5 and 15 minutes after birth. T h e temperatures of the two groups were compared. T h e conclusion: “ T h e procedure of removing a normal newborn from his mother and placing him in a heated bed to keep him warm may be unnecessary.” T h e authors could find no study which focused o n the probability that the parents’ body heat might
28 7
Table 1. Mean Rectal Temperatures Among 100 Newborns with Two Sources’ of External Heat
Pooled T Value
Variance Degrees of Freedom
Estimate 2-Tail Probability
0.604
-0.46
98
0.650
1.16
0.609
- 1.40
98
0.165
1.09
0.769
-0.85
98
0.396
0.’12 0.1 32
1.39
0.254
0.79
98
0.429
0.099 0.107
1.17
0.593
0.51
98
0.612
Newborns Number
Temperatures
SDt
TEMP 1- After routine care not held 50 98.6416 0.993 held 50 98.7357 1.070 TEMP 2-After five minutes (held or in transporter) not held 50 97.7477 0.993 held 50 98.01 56 0.923 TEMP 3--On admission to nursery not held 50 97.1 357 0.942 held 50 97.2998 0.983 TEMP 4--First follow-up temperature in nursery not held 50 98.3756 0.794 held 50 98.2377 0.936 TEMP 5--Second follow-up temperature in nursery not held 50 98.5576 0.698 held 50 98.4836 0.754
F Value
2-Tail Probability
0‘140 0.151
1.16
0’140 0.1 31
SES
0.139
Held by parent in room with mean temperature 70.9600 or placed in transporter with mean temperature 83.6200
t Standard Deviation $ Standard Error
Data were collected when staff was adequate and sufficient time was available, from August 1977 through October 1977 at Pennsylvania Hospital. During this period there were approximately 750 deliveries. Because the majority of deliveries occurred in delivery rooms 1 and 4, only these rooms were used for the study. A room temperature ranging from 68’ to 72°F was maintained. The formal criteria for sample selection were as follows: 1) newborn weighed over 5+ pounds, 2) normal labor and vaginal delivery, 3) Apgar score of 7-10 at five minutes, and 4) no newborn complications. A checklist was posted in each delivery room for the purpose of recording the following: whether the infant was held or placed in the transporter; the newborn’s name; Methods and Material rectal temperature after routine T h e study was experimental, with care; rectal temperature five minutes a sample of 100 infants. A control later; room or transporter tempergroup of 50 infants not held but ature at same time as rectal temperplaced in the transporter and an ex- atures; and whether or not sedation perimental group of 50 infants held h a d been administered t o t h e by the mother and/or father were mother immediately before delivery. used. The staff was instructed in the Rectal temperatures were monitored methods for gathering data, proce- with electronic thermometers. With both groups, after the baby dures, and selection criteria. (To ensure uniform procedure, a pilot pack had been opened, two baby study had been conducted for a pe- blankets had been placed in the riod of one week.) transporter to be warmed by its
serve as a source of warmth for their newborn and thus prevent excessive heat loss. [Editor’s note: However, one such study has since appeared in JOGN. See Gardner S: The mother as incubator-after delivery, JOGN 8:174- 176, May/June 1979. Please also refer to this article for a fuller review of newborn heat loss, heat loss compensation, and heat dissipation.] T h e purpose of this research was to test the hypothesis that if the newborn is dried, given initial care, properly wrapped, and then placed in the mother’s and/or father’s arms for a period of five minutes, there will not be a significant decrease in the newborn’s temperature as compared to newborns who are not held but placed in a heated transporter.
288
heating element. One of these blankets was then used to wrap the baby during the weighing. In conjunction with this, to minimize convective heat loss, the scale was moved in close proximity to the IMI (radiant heat bed). The staff had been reminded of the method of properly drying and wrapping the baby with special emphasis placed on covering the head. Both groups of infants were wrapped in the second warmed blanket. Both groups arrived in the nursery via warmed transporter within 40 minutes following delivery. Admission temperatures were recorded and follow-up temperatures were obtained according to nursery routine, i.e., 8:OO AM and 4:OO PM. This information was gathered by the authors.
Analysis of Data Means and standard deviations of both groups’ temperatures were calculated for all five temperature recordings (see Table 1). The t test for significant difference between temperature readings of the control and experimental groups was used. In addition to these, cross-tabulations were employed for all five temperature recordings of each group to determine incidence of temperatures falling within the normal range (97-
99'F)' or otherwise. T h e decision to use these values as the normal range was based on the fact that most authorities refer to a normal range of temperature rather than a specific average temperature, although average temperature ranges do differ from study to study." According to one author, the rectal temperatures of infants varies between 97.6' and 99.8"F, with an occasional range of 97.0' to 100.6"F.' Another author found that temperatures as low as 97.O"F and as high as lOO'F occurred in normal newborns.8 A range as wide as 96" to 99.5'F was cited by another pair of authors;" however, most sources agree that rectal temperatures should not fall below 97°F." A range of 97' to 99OF falls within the normal ranges observed by the above authors and was thus designated as the normal range for this study.
Results Figure 1 shows the mean of each of the five rectal temperature recordings of all 100 newborns. Temperatures taken five minutes after newborns were either held or placed in the heated transporters decreased nearly l'F, falling from 98.6O to 97.8'F. Temperature 3, the temperature obtained on admission to the nursery, proved to be the lowest mean temperature of the five obtained; however, it was still within a normal range (97'-99'F) at 97.2'F. Means of two follow-up temperatures show an inclination to return to a range closer to Temperature 1, the first taken after delivery, with a difference of 0.168"F between Temperatures 1 and 4, the first temperature taken in the nursery. Table 1 compares the mean rectal temperatures of the control and experimental groups for each of the five successive recordings. Standard deviations and standard errors of the means are also given in the table. Differences between temperatures of control a n d experimental groups through the five recordings range from 0.0740' to 0.2679'F. The hypothesis, that there is no significant difference in rectal temperatures of newborns held by parents following proper drying and
98.9 98.8 98.7 98.6 98.5 98.4
k Y
98.3
a I
98.1
I
d
Ba
\
98.2
\
i
98.0 97.9 97.8
0
97.7 1
97.6 97.5 I
97.4 97.3
97.1 97.2 97.0
I
: TEMP 1 TEMP 2 TEMP3 TEMP4 TEMPS ~~
Figure 1. Means of successive rectal temperatures of 100 newborns (i.e. both experimental and control groups)
wrapping and newborns not held after the same conditions but placed in a warmed transporter, was confirmed at both the .05 and .01 levels using a two-tailed t test. Table 2 shows comparisons of temperatures 1-5 with a normal temperature range of 97'-99"F. Table 2 shows a close balance between the control and experimental groups and the incidence of normal and abnormal temperature ranges
occurring between them. Temperature 2 shows a slightly higher incidence of below normal range temp e r a t u r e s o c c u r r i n g within t h e control group.
Conclusions According to results plotted in Figure 1, it appears that although newborn body temperatures do show a slight decrease from the initial recording, the decreased temperature
Table 2. Comparison of Mean Rectal Temperatures Among 100 Newborns Below Normal
Normal *
Above Normal
30 28
19 20
35 38
4 6
31 32
2 1
43 41
5
36 39
13
____TEMP 1-After routine care 1 not held 2 held TEMP 2-After five minutes (held or in transporter) 11 not held 6 held TEMP 3---0n admission to nursery 17 not held 17 held TEMP 4-First follow-up temperature in nursery 2 not held 2 held TEMP 5-Second follow-up temperature in nursery 1 not held 1 held
7
10
Normal range = 9 7 " - 9 9 " F
289
reading still remains within the nor- m o n i t o r e d w i t h e l e c t r o n i c thermal range. Also noteworthy is the mometers; there are sources to valifact that temperatures did return to date both pro a n d con opinions. Anwithin 0.2’F of the initial temper- other point which perhaps can be ature recording in a matter of hours. considered a limitation is that the These results indicate that whether time element between the admission h e l d b y p a r e n t s o r not h e l d b u t temperature a n d the first follow-up placed in a heated transporter, new- temperature was not consistent beborns recover the minimal amount cause temperatures after admission to the nursery were taken either at of heat loss suffered. T test results as shown in Table 1 8:OO A M or at 4:OO P M regardless of imply that allowing parents to expe- t i m e of delivery. T h e n of course rience a period of contact with their there is the possibility that d u e to newborns, i.e., allowing t h e m t o human error in d a t a collection all of hold a n d fondle the infant, does not the participants did not conform to affect the newborn body temper- the designated criteria. a t u r e as monitored with a rectal thermometer relative to those new- Implications for Further Research borns who are warmed by mechaniInasmuch as a fair portion of temcal devices. peratures monitored for each of the Cross-tabulations indicate that al- control a n d the experimental groups though t h e numbers of newborns fell below the normal range, a n d falling within the ranges of below more specifically those temperatures normal, normal, a n d above normal taken prior to a n d on admission to for both experimental a n d control the nursery, further research may be groups remain fairly even, a sizeable indicated to determine the optimal number of newborns register tem- ambient temperature in the delivery peratures below normal for Temper- room. atures 2 a n d 3. Also, i n view of t h e l i m i t e d Questions posed by the authors amount of research available cona r e answered as follows: 1) There is cerning the accuracy a n d efficiency n o significant difference in temper- of electronic thermometers, further atures of newborns who are held by research in this area may prove bentheir parents prior to being placed in eficial. a warmer a n d infants who a r e placed directly in a mechanically Acknowledgments heated device. 2) Newborn physioT h e authors wish to express their logic reactions to changes in temper- appreciation to R i t a Morris, R N ; ature do not support the practice of Merle Sutton, RN; the entire labor denying parents anything more than a n d delivery staff a t Pennsylvania a cursory glance at their newborn af- Hospital; Ronald Bolognese, M D ; ter birth. 3) Slight adaptations in de- T h o m a s R. Boggs, M D ; Dorothy livery room routines maintain the Brooten, RN, MSN; a n d Barbara temperature of the newborn suffi- Jacobsen, MS, for their assistance ciently to allow parents more time to a n d support. become acquainted with their newReferences born. 1. Blackburn G, Motil KJ: TemperLimitations ature regulation in the neonate. Clin T h e r e are some who may question Pediatr 12:634-638, 1973 the accuracy of rectal temperatures 2. Phillips CRN: Neonatal heat loss in
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4.
5.
6. 7. 8.
9. 10.
heated cribs vs. mothers’ arms. JOGN Nurs 3:11-15, 1974 Hull D: Temperature regulation disturbance in the newborn infant. J Clin Endocr Metab 5:39-53, 1976 Dahm LS, James LS: Newborn temperature and calculated heat loss in t h e delivery room. Pediatrics 49:504-512, 1972 Brooten D, Miller MA: The Childbearing Family: A Nursing Perspective. First Edition. Boston, Little Brown, 1977 Eoff MJ, Meier RS, Miller C: Temperature measurement in infants. Nurs Res 23:457-460, 1974 Barnett HL: Pediatrics. Fifteenth Edition. New York, Appleton-Century-Crofts, 1968 Marlow DR: Textbook of Pediatric Nursing. Fourth Edition. Philadelphia, WB Saunders, 1973 Lutz L, Perlstein PH: Temperature control in newborn babies. Nurs Clin N Am 6:15-23, 1971 Vulliamy DG: T h e Newborn Child. Third Edition. Boston, Little, Brown, 1972
Address for correspondence: Susan Hill, RN, Perinatal Testing Nurse, Pennsylvania Hospital, Eighth and Spruce Street, Philadelphia, PA 19107.
Susan Hill is a perinatal testing nurse and coordinator ofthe Program for Childbirth Education at the Pennsylvania Hospital in Philadelphia. She has worked as a staff nurse in labor and delivery and in the intensive care nursery. Ms. Hill received her diploma from the University of Pennsyluania School of Nursing, Philadelphia, and is working toward her BSN from Gwynedd-Mercy College, Gwynedd V a l l v , Pennsylvania. She is a member of NAACOG, ICEA, and CCES. Lucille Shronk recieued her BSNfrom Thomas J elferson University College of Allied Health Sciences, Philadelphia, Pennsylvania. She is a stalfnurse in labor and delivery at I’ennsylvania Hospital, Philadelphia, and is a member of NAACOG.
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